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Presented by Prof Lore Decoster, medical oncologist (UZ Brussels) and board member and Belgian representative of the International Society of Geriatric Oncology
In the G-oncoCOACH study, the impact of intensive patient coaching on individuals undergoing systemic cancer treatment was investigated. This randomized controlled trial enrolled geriatric patients aged over 70 with a solid tumour, receiving first or second-line treatment in either a curative or palliative context. Geriatric assessments were conducted for all patients, with the control group receiving coordination by the oncology team, and the intervention group receiving coordinated oncology team care along with intensive patient coaching. The hypothesis posited that coaching would enhance treatment compliance and patient empowerment.
Baseline Quality of Life (QoL) assessments were comparable among the 217 patients subjected to 1:1 randomization. Throughout the study, the control group exhibited a decline in QoL, while the intervention group demonstrated a significant increase. This improvement in QoL was both statistically and clinically significant, with a 12.8-point increment at the six-month mark. These findings underscore the importance of geriatric assessments in evaluating QoL, which can be positively influenced by appropriate patient coaching, even in the context of oncological interventions.
For geriatric patients undergoing chemotherapy, the CARG toxicity tool could be employed to estimate the risk of severe chemotherapy-related side effects (≥grade 3). Factors considered include age, tumour type, chemotherapeutic agent, biological markers such as haemoglobin and creatinine clearance, and specific geriatric features such as mobility, medication independence, and social environment.
In a multicenter, randomized control study involving patients with biliary tract, oesophagal, gastric, or gastroesophageal cancer, participants were randomized into a control group receiving 100% of the chemotherapy dose or an experimental group receiving a dose calculated based on the risk assessed by the CARG tool. Patients were categorized into low, medium, or high-risk groups, receiving 100%, 80%, or 60% of the standard chemotherapy dose, respectively. This non-inferiority study focused on OS as the primary endpoint. Preliminary data from the pilot study, involving 42 patients, revealed comparable PFS (p-value 0.96). The risk-based chemotherapy dosing group experienced significantly fewer high-grade toxicity adverse events (14%) compared to the standard care group (22%). This study emphasizes the importance of assessing treatment toxicity risk using the CARG tool to shield older patients from therapy-related toxicity, thereby preserving their health status and QoL.
The impact of physical exercise in frail patients undergoing colorectal cancer surgery was investigated. Patients were randomized into a control group and an exercise program group, engaging in exercise twice a week for 12 weeks post-surgery. The primary endpoint was physical functioning 14 weeks after surgery, assessed through a 6-minute walking test, a 5-times stand-up from a chair test, and a handgrip test estimating hand and forearm strength. Patients adhering to the exercise program demonstrated less physical decline compared to the control group. Given the heightened risk of physical and functional decline in elderly and frail patients during cancer treatment, exercise interventions prove valuable in enhancing and preserving physical fitness and QoL.
References:
Kenis, C. et al. (2023) RCT for CGA effectiveness on QoL in older patients with solid tumors + systemic therapy: G-oncoCOACH. Journal of Geriatric Oncology, Volume 14, Issue 8, S6 – S7
Kumar A. et al. (2023) Randomized phase III clinical trial:Non-inferiority of reduced dose chemotherapy based on CARG. Journal of Geriatric Oncology, Volume 14, Issue 8, S1 – S2
Dolin TG et al. (2023) Effect of geriatric intervention on physical function in patients operated for colorectal cancer. Journal of Geriatric Oncology, Volume 14, Issue 8, Supplement 1, S1